10 benefits of the PMJAY Ayushman Bharat Yojana

Read more about the key features of the Prime Minister’s public health programme.
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10 benefits of the PMJAY Ayushman Bharat Yojana
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3 mins
15 July 2023

The Ayushman Bharat Yojana, now called the Pradhan Mantri Jan Arogya Yojana (PMJAY), aims to be one of the world's largest health insurance schemes. It aims to offer a health insurance plan of Rs. 5 lakh annually per family for secondary and tertiary care hospitalisation, benefiting over 12 crore vulnerable families. The selection of households is based on the deprivation and occupational criteria outlined in the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.

PMJAY is a fully funded initiative by the Government, with implementation costs shared between the Central and State Governments. By alleviating the financial burden of healthcare expenses, PMJAY strives to ensure equitable access to quality medical services, thus contributing significantly to the welfare and well-being of millions of families across India. In this article, we will discuss in detail Ayushman card benefits that will highlight the requirement of health insurance schemes to ensure quality healthcare benefits for all in the country.

Understanding Ayushman card benefits: A comprehensive guide

Launched by the Government of India, the Ayushman Bharat Yojana, or Pradhan Mantri Jan Arogya Yojana, is geared towards offering healthcare benefits to economically disadvantaged segments of society. Rolled out in September 2018, it stands as the world's largest government-funded healthcare program, offering extensive PMJAY benefits and Ayushman card benefits.

The Ayushman Bharat Yojana, offers cashless healthcare benefits of up to Rs. 5 lakh per eligible family per year. The benefits can be availed at empanelled hospitals and healthcare providers across the country. As one of the most significant healthcare schemes (Health Insurance) on a global scale, it aims to cover approximately 50-crore people in India.

The PMJAY scheme offers a range of healthcare services. They include diagnostic tests, doctor consultations, and treatment for a variety of diseases. It also covers secondary and tertiary hospitalisation expenses. Also, Intensive care unit (ICU) charges and other related medical expenses.

Also, check: Ayushman card

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Top benefits of Ayushman Card (PMJAY) scheme

Here are the top 10 primary benefits of the PMJAY scheme for the vulnerable sections of society.

1. Healthcare cover of Rs. 5 lakh per family

Launched in September 2018 by the Prime Minister, the Ayushman Bharat Yojana aims to cater to 50 crore beneficiaries. It provides a health cover of Rs. 5 lakh to families living below the poverty line. The health cover is free, as the central and state governments pay the annual premiums in a 60:40 ratio.

2. All families listed in the SECC database to be covered

Beneficiaries for the scheme are picked up from the Socio-Economic Caste Census (SECC) of 2011. These ten crore beneficiary families comprise eight crore families from the rural areas and two crore families residing in urban India.

3. Priority to the girl child, women and senior citizens

There is no cap on the family size and age as this health cover is inclusive for all. Moreover, the scheme holds women, children, especially girls and those over 60 in special regard.

4. It includes secondary and tertiary care

The scheme provides those in need to get secondary healthcare benefits offered by specialists like cardiologists and urologists. Moreover, advanced medical treatment like that for cancer, cardiac surgery and others is also covered.

5. All pre-existing diseases covered

The PMJAY covers pre-existing illnesses and makes mandatory treatment in all public hospitals, unlike most other insurance covers. This means that those who require medical care cannot be turned away.

6. Cashless and paperless registration and administration

Removing the burden of out-of-pocket expenses, PMJAY aims to make the entire process of paying for healthcare cashless. Additionally, PMJAY beneficiaries can seek treatment across India.

7. Substantial reduction of out-of-pocket expenditure

All public and empanelled private hospitals cannot charge any extra payment for medical care from all PMJAY beneficiaries. This is to reduce any corruption or delay in services.

8. Private sector participation in helping to achieve public health goals

Since the scheme covers such a large population, it will be purchasing services from private healthcare providers. This scheme is also expected to encourage the production of more affordable healthcare equipment and drugs.

9. Improvement of quality of life of the population

This scheme will improve the quality of life of the weaker sections of society. They will get timely care and finances to tackle their health issues.

10. Broadening the health insurance network

PMJAY will lead to better infrastructure development in rural and under-served areas across the country. This will lead to more Indians having access to healthcare. The government has created 1,350 medical packages that cover a range of health services. This includes daycare treatment, surgery, hospitalisation, and medicines with the PMJAY health cover.

Exploring the benefits of Ayushman card: Key features and coverage

Given below are the key Ayushman Bharat card benefits:

Cashless healthcare:

Under the scheme, eligible individuals can avail of cashless healthcare services for up to Rs. 5 lakh per family per year. The service can be availed at empanelled hospitals and healthcare providers.

Eligibility criteria:

The scheme is available to families that are identified as deprived and vulnerable based on the Socio-Economic Caste Census (SECC) 2011 data.

Health coverage:

PMJAY provides coverage for a range of health services, including medical procedures, diagnostic tests, consultation, and treatment for a variety of ailments and diseases. It also covers secondary and tertiary hospitalisation expenses.

Pan-India coverage:

The scheme is applicable across the country, and eligible individuals can access healthcare services at any empanelled hospital or healthcare provider, regardless of their location.

Paperless and cashless transactions:

The PMJAY scheme operates on a paperless and cashless mode. All transactions made under the scheme are done through an online portal, eliminating the need for cash transactions.

Pre and post hospitalisation expenses:

PMJAY provides coverage for pre-hospitalisation expenses for up to 15 days before hospitalisation and post- hospitalisation expenses for up to 60 days.

Portability:

The scheme provides portability of benefits, allowing beneficiaries to access healthcare services at any empanelled hospital or healthcare provider, regardless of their location.

No age limit:

PMJAY does not have any age limit, and all eligible individuals can benefit from the scheme's coverage.

Empanelled hospital network:

PMJAY has an extensive network of empanelled hospitals and healthcare providers across the country, ensuring that eligible individuals can access healthcare services without any hassle.

Eligibility for PM-JAY healthcare scheme in rural and urban areas

The scheme has defined beneficiaries for rural and urban areas. Given below is the distribution for the same:

Rural beneficiaries

D1- Only one room with kucha walls and kucha roof.

D2- No adult member between ages 16 to 59.

D3- Households with no adult male member between ages 16 to 59.

D4- Disabled member and no able-bodied adult member.

D5- SC/ST households.

D7- Landless households deriving a major part of their income from manual casual labour.

Urban beneficiaries

For urban areas, the following 11 occupational categories of workers are eligible for the scheme:

  • Ragpicker
  • Beggar
  • Domestic worker
  • Street vendor/cobbler/hawker/other service provider working on streets
  • Construction worker/ plumber/mason/labour/painter/welder/ security guard/ coolie and other head-load worker
  • Sweeper/sanitation worker/mali
  • Home-based worker/artisan/handicrafts worker/Tailor
  • Transport worker/ driver/ conductor/ helper to drivers and conductors/ cart puller/ rickshaw puller
  • Shop worker/ assistant/ peon in small establishment/ helper/delivery assistant / attendant/ waiter
  • Electrician/ mechanic/ assembler/ repair worker
  • Washer-man/ chowkidar

ABHA Card

Pradhan Mantri Jeevan Jyoti Bima Yojana

Beneficiary NHA

PMJAY Registration

Frequently asked questions

How to apply online for the Ayushman Bharat Yojana?

To apply for Ayushman Bharat Yojana online, follow the steps below:

  • Visit the official website of Ayushman Bharat - https://pmjay.gov.in/
  • Click on the 'Am I Eligible?' tab and enter your mobile number
  • Enter the Captcha code and click on 'Generate OTP'
  • Enter the OTP received on your mobile number and click on 'Verify OTP'
  • Enter the required details, including your name, address, and Aadhaar number
  • Submit the application
What services are offered under the Ayushman Bharat Scheme?

The Ayushman Bharat Scheme covers a range of healthcare services, including:

  • Medical consultations, diagnostic tests and treatment
  • Surgical procedures and interventions
  • Hospitalisation expenses
  • Medical expenses related to critical illnesses
What are the critical diseases covered under the Ayushman Bharat Health Scheme?

Some of the critical illnesses that are covered under the Ayushman Bharat Health Scheme include:

  • Cancer
  • Cardiovascular diseases
  • Parkinson's disease
  • Kidney failure
  • Burns
  • Neonatal diseases
  • Mental illnesses
What is the process to get an Ayushman card?

To get an Ayushman card, eligible individuals need to follow the below steps:

  • Eligible individuals are identified through the Socio-Economic Caste Census (SECC) data.
  • The beneficiaries are identified by the National Health Authority and provided with an Ayushman card.
  • The Ayushman card contains all the necessary information about the beneficiaries, including their name, age, and Aadhaar details.

Eligible individuals can use the Ayushman card to avail of cashless healthcare benefits up to INR 5 lakhs per family per year at empanelled hospitals and healthcare providers across the country.

Is Ayushman Bharat health card free?

Yes, Ayushman Bharat health card is free for eligible beneficiaries.

What are the key exclusions in Ayushman Bharat health scheme?

The key exclusions in Ayushman Bharat health scheme include cosmetic surgery, dental procedures, and organ transplants. It also does not cover treatment of lifestyle diseases like obesity, infertility, and mental illness.

Who is eligible for Ayushman card?

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health coverage for economically vulnerable families in India. Eligibility is determined based on the Socio-Economic Caste Census (SECC) data. Families identified as deprived and lacking access to healthcare are eligible for the Ayushman card, ensuring financial protection for hospitalisation expenses.

Is Ayushman card valid for everyone?

No, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is specifically for economically vulnerable families identified through the Socio-Economic Caste Census (SECC) data. Not everyone is eligible. The scheme aims to provide health coverage and financial protection for those lacking access to healthcare among the identified deprived households.

Which diseases are not covered under Ayushman Bharat?

Given below is the list of diseases not covered in the Ayushman Bharat scheme:

  • Outpatient department (OPD) consultations and procedures
  • Fertility-related treatments such as in-vitro fertilisation (IVF)
  • Cosmetic surgeries and procedures
  • Dental treatments and procedures
  • HIV/AIDS treatment
  • Drug and alcohol rehabilitation
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